The U.S. Supreme Court, in a potential landmark decision, upheld Tennessee’s law prohibiting gender affirming care for minors, saying children who seek the treatment don’t qualify as a protected class.

In United States v. Skrmetti, the high court overturning a lower court’s finding that the restrictions violate the constitutional rights of children seeking puberty blockers and hormones to treat gender dysphoria. The U.S. Court of Appeals overturned the district court’s decision and sent it to the high court.

The court’s three liberal justices dissented, writing that the court had abandoned transgender children and their families to “political whims.”

Tennessee lawmakers passed the legislation in 2023, leading to a lawsuit argued before the Supreme Court last December. The federal government, under the Biden administration, took up the case for the American Civil Liberties Union, Lambda Legal and three transgender teens, their families and a Memphis doctor who challenged the law, but the U.S. Department of Justice under President Donald Trump dropped its opposition.

In its ruling, the court said that the plaintiffs argued that Senate Bill 1 “warrants heightened scrutiny because it relies on sex-based classifications.” But the court found that neither of the classifications considered, those based on age and medical use, are determined on sex.

“Rather, SB1 prohibits healthcare providers from administering puberty blockers or hormones to minors for certain medical uses, regardless of a minor’s sex,” the ruling states.

The ruling says the application of the law “does not turn on sex,” either, because it doesn’t prohibit certain medical treatments for minors of one sex while allowing it for minors of the opposite sex.

The House Republican Caucus issued a statement saying, “This is a proud day for the Volunteer State and for all who believe in protecting the innocence and well-being of America’s children. Tennessee House Republicans are pleased by the court’s courage to stand firm against ideology that denies biological reality. The sterilization and disfigurement of children will no longer be normalized. As we celebrate the precedent set by this decision, we remain committed to leading the nation in safeguarding the health, safety and future of all children.”

Senate Majority Leader Jack Johnson, who sponsored the bill, said he is grateful the court ruled that states hold the authority to protect children from “irreversible medical procedures.”

“The simple message the Supreme Court has sent the world is ‘enough is enough,’” Johnson said in a statement.

The Tennessee Equality Project, an LGBTQ advocacy group, expressed dismay at the decision: “We are profoundly disappointed by the U.S. Supreme Court’s decision to side with the Tennessee legislature’s anti-transgender ideology and further erode the rights of transgender children and their families and doctors. We are grateful to the plaintiffs, families, and the ACLU for fighting on behalf of more than across the nation.”

The group said gender-affirming care saves lives and is supported by medical groups such as the American Academy of Pediatrics and the American Medical Association.

The court also rejected plaintiffs’ argument that the law enforces “a government preference that people conform to expectations about their sex.” 

The court found that laws that classify people on the basis of sex require closer scrutiny if they involve “impermissible stereotypes.” But if the law’s classifications aren’t covertly or overtly based on sex, heightened review by the court isn’t required unless the law is motivated by “invidious discriminatory purpose.”

“And regardless, the statutory findings on which SB1 is premised do not themselves evince sex-based stereotyping,” the ruling says.

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was originally reported by Orion Rummler of . .

On Thursday, the Department of Health and Human Services (HHS) published a of research on gender-affirming care for transgender youth, as directed by President Donald Trump. The agency used the release of the report to that available science does not support providing gender-affirming care to trans youth. LGBTQ+ advocacy groups worry the report will be used to further restrict gender-affirming care and to change medical guidelines in ways that harm trans youth.

The president mandated the report in an condemning the medical treatment — without evidence — as a form of mutilation, amid a broader push by the administration to from public life. Trump’s order asked the health agency to review the “best practices for promoting the health of children who assert gender dysphoria,” while to halt treatment or lose federal funding.

Now, the HHS has produced that report. The agency combed through research on the outcomes of puberty blockers, hormone replacement therapy, social transition, psychotherapy, and the rare cases of surgeries on adolescents and young adults diagnosed with gender dysphoria. 

Gender dysphoria, the reason that most trans people undergo , is a strong and persistent distress felt when one’s body is out of sync with their gender identity. Without treatment, gender dysphoria can lead to severe negative impacts in day-to-day life. 

The agency states in its of the report that the document is not meant to provide clinical practice guidelines or issue legislative or policy recommendations. However, the report does imply that health care providers should refuse to offer gender-affirming care to adolescents and young adults on the basis that such care comes with the potential for risk — despite little evidence for that risk actually being found in the report. 

“The evidence for benefit of pediatric medical transition is very uncertain, while the evidence for harm is less uncertain,” the executive summary states. “When medical interventions pose unnecessary, disproportionate risks of harm, healthcare providers should refuse to offer them even when they are preferred, requested, or demanded by patients.”

In its research review, the HHS determined that evidence measuring the effects of gender-affirming care on psychological outcomes, quality of life, regret and long-term health is of “very low” quality. This conclusion ignores decades of research, as well as a recent survey of in the United States that found an overwhelming majority report more life satisfaction after having transitioned. Access to gender-affirming care has been linked to and depression in trans youth, while gender-affirming surgeries have been found to for adults.

Even when analyzing research that the administration deemed low-bias, the HHS found “sparse” to no evidence of harm from gender-affirming care. What’s more, the report frequently found evidence demonstrating the benefits of gender-affirming care — though it ultimately downplays those findings as not significant. 

Available research on puberty blockers found high satisfaction ratings and low rates of regret. A systematic review of hormone replacement therapy described improved gender dysphoria and body satisfaction. Another found that hormone treatment leads to improved mental health. Two before-and-after studies reported reduced treatment needs or lower levels of suicidality and self-harm after hormone treatment. When measuring safety outcomes of hormone treatment, side effects did not have a major impact on treatment and complications were limited. 

Despite these findings, the Department of Health and Human Services advertised the report in a Thursday as one that “highlights a growing body of evidence pointing to significant risks” of gender-affirming care. At the White House briefing room Thursday, deputy chief of staff for policy Stephen Miller touted the new report and attributed the idea of being transgender as part of a “cancerous communist woke culture” that is “destroying this country.” 

There are side effects to many of the medications that transgender people — and cisgender people — take to receive gender-affirming care, as is the case with most medical treatments. These side effects, like the risk of decreased bone density when taking puberty blockers, are and communicated to patients.

LGBTQ+ advocacy organizations denounced the report as a political attack on transgender youth. Multiple groups said that the report’s endorsement of psychotherapy as a “noninvasive alternative” to puberty blockers and hormone treatment amounts to an endorsement of conversion therapy — a practice wherein mental health professionals try to change a youth’s sexual orientation or gender identity.

“It is already clear that this report is a willful distortion of the evidence intended to stoke fear about a field of safe and effective medicine that has existed for decades, in order to justify dangerous practices which amount to conversion therapy,” said Sinead Murano Kinney, health policy analyst at Advocates for Trans Equality. 

The Human Rights Campaign, the country’s largest LGBTQ+ rights organization, accused the HHS of producing a report that is attempting to lay the groundwork to replace medical care for trans and nonbinary people with conversion therapy. 

“Trans people are who we are. We’re born this way. And we deserve to live our best lives and have a fair shot and equal opportunity at living a good life,” said Jay Brown, chief of staff at the Human Rights Campaign. “This report … lays the groundwork to push parents and doctors aside and allow politicians to subject our kids to the debunked practice of conversion therapy.” 

No authors or contributors are named in the report or in its executive summary. The agency says these names are being initially withheld to “maintain the integrity of this process,” and states that chapters of the document were subject to peer review.